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PubMed1987

An evaluation of the clinical analgesia/anesthesia efficacy on acute pain using the high frequency neural modulator in various dental settings.

The purpose of this study was to evaluate the effectiveness of high frequency neural modulation as a substitute for traditional local anesthesia in various dental procedures. This double-blinded study was done to evaluate patient comfort and degree of satisfaction as well as manageability of pain control by the operator during the dental procedures. Procedures included restorations, tooth extractions, root planing, pulp extirpation, and temporomandibular joint therapy. In the experimental group, favorable responses ranged from 0.0% to 92.8%, depending on the procedures. An overall favorable rating of 71.8% was given by the experimental group, and an overall favorable response of 8.5% was given by the placebo group.

Acute Disease↗
PubMed1992

Postscaling bacteremia in HIV-associated gingivitis and periodontitis.

Aseptic venipuncture was used to obtain samples of blood from 22 patients seropositive for human immunodeficiency virus (HIV) with gingivitis (HIV-G) and 19 HIV-seropositive patients with periodontitis (HIV-P), 15 and 30 minutes after the initiation of routine dental scaling and root planing. The presence of colony forming units in 1.2 ml aliquots of blood collected with the Isostate system (DuPont Isostat System, Doraville, Ga.) was assayed on trypticase soy blood agar. Six of the samples from HIV-G subjects were positive for colony forming units 15 minutes after scaling but not at 30 minutes. Similar evidence of bacteremia was found in seven of the HIV-P patients 15 minutes after scaling was initiated in this group, with no microbial growth detectable in samples obtained at 30 minutes. In two HIV-G and three HIV-P patients with demonstrable bacteremias a postoperative fever developed. For both HIV-G and HIV-P groups no significant difference was found between the absolute CD4 T-cell counts of nonbacteremic versus bacteremic patients (p greater than 0.05). These observations suggest that special provisions for antibiotic prophylaxis in this patient group may be unnecessary.

Adult↗
PubMed1994

Antimicrobial mouthrinses: impact on dental hygiene.

Within the assessment, planning, implementation, and evaluation phases of the dental hygiene process of care model, the hygienist can decide which antimicrobial mouthrinse is best suited for a patient's given periodontal condition. First, the initial periodontal condition and the home care of the patient is assessed. Next, the hygienist can plan which protocol, in-office and/or at-home, will best meet the needs of the patient. Implementation of a program can include antimicrobial mouthrinses as an adjunct to scaling and root planing in the office, and the mechanical removal of plaque at home. Finally, the hygienist can evaluate the concerted efforts of both patient and clinician. Patients with extensive crowns and bridges, implants, and orthodontics can also benefit from the use of antimicrobial mouthrinses.

Aerosols↗
PubMed2000

Measurement of proteases in human subgingival dental plaque by fluorescence polarization.

Fluorescence polarization (FP) was examined as a rapid quantitative method to assay the proteases in subgingival plaque. Protease activity was measured by a decrease in FP at 0.5-min intervals over 5 min, using BODIPY-alpha-casein, a protein substrate. To quantitate activity, the least absolute deviation (LAD) slope for each assay was determined. Protease activity increased with the quantity of plaque (r=0.416, P<0.001). Of the 208 subgingival plaque samples, 87 contained detectable protease activity, with a mean of about 4 microg trypsin equivalents above a general background of 1 microg per site. The mean plaque protease activity of 89 paired samples from 15 individuals had decreased by 1.1 microg trypsin equivalents per site when measured at 8 months after tooth scaling and root planing (P<0.01). Most isolates of Porphyromonas gingivalis, Treponema denticola, Prevotella nigrescens, and Prevotella intermedia implicated in the pathogenesis of adult periodontitis exhibited high activity in the FP assay. The assay is rapid, quantitative and requires only one-tenth of the plaque sampled using a single pass with a Gracey curette at a single tooth site.

Adult↗
PubMed1999

The effects of disclosure on pain during dental hygiene treatment: the moderating role of catastrophizing.

Catastrophizers and non-catastrophizers were asked to disclose about their dental worries prior to undergoing dental hygiene treatment. It was hypothesized that the effects of emotional disclosure would vary as a function of the level of catastrophizing; where catastrophizers would be more likely than non-catastrophizers to show reductions in pain and emotional distress. The study also examined whether emotional disclosure influenced subsequent levels of catastrophizing and dental anxiety. Eighty undergraduate students were randomly assigned to a disclosure condition or a control condition prior to undergoing a scaling and root planing procedure. In the control condition, catastrophizers reported significantly more pain and emotional distress than non-catastrophizers. In the disclosure condition, catastrophizers and non-catastrophizers did not differ significantly in their pain and emotional distress. The interaction between condition and level of catastrophizing remained significant even when controlling for emotional distress and the emotional content of the thought records. While catastrophizers benefited from disclosure in regard to their immediate physical and emotional experience, their levels of catastrophizing and dental anxiety remained essentially unchanged. Theoretical and clinical implications of the findings are discussed.

Adult↗
PubMed1994

Experimentally induced peri-implant mucositis. A clinical study in humans.

The purpose of this study was to compare the clinical and microbiological (microscopic) parameters during the development of experimental gingivitis and experimental peri-implant mucositis. Twenty partially edentulous patients were treated for moderate to advanced periodontal disease. Following active periodontal therapy consisting of motivation, instruction in oral hygiene practices, scaling and root planing and periodontal surgery where indicated, IMZ oral implants were incorporated in posterior edentulous areas. After 3 months of healing, the prosthetic abutments were connected, and the patients were closely supervised for another 2 months of healing. At this time, baseline data were obtained. Re-examinations were scheduled at 3 and 6 months. Following this, the patients were asked to refrain from oral hygiene practices for 3 weeks. At all examinations including the end of the period of no oral hygiene, the following clinical parameters were obtained: Plaque Index, Gingival Index and Sulcus Bleeding Index, all modified by Mombelli et al. (1987), probing pocket depths and recession in mm. Furthermore, submucosal/subgingival plaque samples were obtained and analyzed using phase contrast microscopy. At the end of the 3-week period of plaque accumulation, optimal oral hygiene was reinstituted. There were no statistically significant differences between the mean values of all parameters at implant compared to tooth sites at any observation periods. The period of no oral hygiene demonstrated a similar cause-effect relationship between the accumulation of bacterial plaque and the development of peri-implant mucositis as established for the gingival units by the experimental gingivitis model.

Adult↗
PubMed1999

The effect of a triclosan/copolymer dentifrice on healing after non-surgical treatment of recurrent periodontitis.

The present study examined whether the daily use of a triclosan/copolymer dentifrice enhanced healing following non-surgical periodontal therapy at sites with progressive attachment loss in periodontitis-susceptible subjects: 60 subjects who had been (i) treated for advanced periodontal disease using nonsurgical means and (ii) had been enrolled, for at least 3-5 years, in a maintenance care program that called for prophylaxis once every 3 months. During the course of this maintenance period, all 60 subjects had suffered recurrent periodontitis at > or = 2 sites at several intervals. Following a baseline examination, all 60 subjects received, on an individual basis, detailed instruction in proper self-performed plaque control methods. They were stratified in 2 balanced groups (test and control groups). The members of the test group were assigned to use a triclosan/copolymer/fluoride-containing dentifrice, while the control group used a placebo dentifrice. During the following 3 years, all participants were recalled every 3 months for an evaluation of their oral hygiene standard. Re-examinations were performed after 6, 12, 24 and 36 months. In conjunction with the re-examinations, sites (loser sites) which exhibited additional probing attachment loss (> or = 2 mm) were identified. The loser sites were exposed to professional therapy. Thus, the site was anaesthetized and the surface carefully scaled and root planed (S/RP). Alterations regarding probing pocket depth (PPD), probing attachment level (PAL), and bleeding on probing (BoP) that occurred in the interval between S/RP and 36 months were analyzed. In the control group, 126 loser sites, 67 identified at the 12-month and 59 at the 24-month examinations, were subjected to S/RP. The corresponding number of loser sites in the test group was 85 (48 at 12 months and 37 at 24 months). At the time of S/RP, about 60% of the sites were BoP (+) in both groups. Following treatment, there was a reduction in the number of sites with gingivitis. While the reduction in the control group was modest (6.8%), in the test group, the improvement was more marked (27.5%). Following S/RP, there was also a reduction of the mean PPD in both groups. This decrease amounted to 1.7 mm in the test group and was significantly (p<0.05) smaller (0.6 mm) in the control. Finally in the interval between S/RP and 36 months, there was an improvement of the probing attachment level in both groups. The mean PAL gain was, however, significantly higher in the test than in the control group (1.8 mm versus 0.7 mm; p<0.01).

Anti-Infective Agents, Local↗
PubMed1999

Some effects of periodontal therapy on local and systemic immunological parameters.

The aim of the present investigation was to study the effect of nonsurgical periodontal therapy on some local (gingival) and systemic host defense characteristics in subjects with advanced periodontal disease. 16 individuals with advanced periodontal disease were recruited. Following a clinical examination, the 3 deepest interproximal sites in the upper and lower premolar- or molar segments were selected for further analysis. Samples from the subgingival microbiota were obtained from the pocket of the selected sites and were prepared for a microbiological examination. The gingival tissue at one of the selected sites was also biopsied. Each excised soft tissue specimen was snap frozen and prepared for immunohistochemical analysis. A sample of peripheral blood was obtained from each individual and prepared for immunohistochemical analysis. Following the baseline examination, all 16 patients received periodontal therapy including oral hygiene instruction and scaling and root planing. Re-examinations regarding the clinical parameters were performed, the subgingival microbiota harvested from the sampling sites and one gingival biopsy was collected at 12 months and 24 months, respectively, among the selected sites. Samples of peripheral blood were obtained from the subjects at the 24-month re-examination. It was demonstrated that non-surgical periodontal therapy effectively reduced symptoms such as gingivitis and probing pocket depth in the subject sample and improved the overall probing attachment level. The treatment applied also markedly reduced (i) the total number of micro-organisms present in selected gingival pockets as well as (ii) the relative proportions of A. actinomycetemcomitans, P. gingivalis and P. intermedia of the subgingival microbiota. The improved clinical condition was, in addition, accompanied by a substantial reduction in the size of the inflammatory lesion (P-ICT) which in the soft tissue samples harvested at baseline was found to reside lateral to the pocket epithelium. Also qualitative alterations occurred in the lesions. Hence, following therapy (i) both the density of CD19 positive cells and the proportion of CD3 positive cells expressing TCR Vbeta genes were reduced in the P-ICT. while (ii) the overall relative number of CD3 positive cells remained unchanged. In conclusion, non-surgical periodontal therapy markedly changed the size and composition of the plaque associated lesion in the gingival tissue but apparently failed to affect the relative distribution of lymphocyte subsets in peripheral blood.

Adult↗
PubMed1999

Discrimination of refractory periodontitis subjects using clinical and laboratory parameters alone and in combination.

The purpose of the present investigation was to use baseline clinical and laboratory parameters to distinguish subjects refractory to conventional periodontal therapy. Baseline clinical, microbial and host parameters were compared in 61 successfully-treated and 27 refractory subjects. Refractory subjects showed mean full-mouth attachment level (AL) loss and/or >3 sites with new AL loss >2.5 mm within 1 year after both scaling and root planing and surgery with systemic tetracycline. Successfully-treated subjects showed mean AL gain and no sites with new AL loss >2.5 mm after either regimen. Gingival redness, bleeding on probing, suppuration, supragingival plaque accumulation, pocket depth and AL were measured at 6 sites per tooth in each subject. The levels of 40 subgingival taxa were determined in subgingival plaque samples from up to 28 sites in each subject using checkerboard DNA-DNA hybridization. Serum antibody (Ab) to 85 subgingival species was determined using checkerboard immunoblotting. Levels of serum IgG2 and Gm23 allotype were measured using radial immunodiffusion; FcgammaRIIa and FcgammaRIIIb receptor haplotypes were determined using PCR and allele specific oligonucleotide probes. Odds ratios of a subject being refractory were determined by comparing measured parameters in the 2 subject groups using univariate and multivariate techniques. 17 of 151 clinical, microbial and immunological variables were significant using chi2 analysis after adjusting for multiple comparisons. For example, the odds ratios of a subject being refractory were 12.2, 5.4 and 6.9 if the subject had Ab >50 microg/ml to >9 species; S. constellatus counts >2.4% of the total DNA probe count or >2.1% of sites with AL >6 mm. The 17 significant predictor variables were used in logistic regression and discriminant analyses. Similar variables were selected using both analyses including the number of serum Ab to subgingival species >50 microg/ml, % S. constellatus in plaque samples and % sites with attachment loss >6 mm. In the logistic regression analysis model, the odds ratios associated with >9 species exhibiting >Ab 50 microg/ml, >2.1% of sites with AL >6 mm and >2.4% S. constellatus in plaque were 8.7, 6.8 and 2.4, respectively, after adjusting for other variables in the model. Discriminant analysis using these variables provided sensitivity, specificity, positive and negative predictive values of 0.66, 0.92, 0.80 and 0.85 respectively. Refractory periodontitis subjects could be distinguished using a subset of clinical, microbiological and immunological parameters.

Adult↗
PubMed2000

Matrix metalloproteinase-8 levels and elastase activities in gingival crevicular fluid from chronic adult periodontitis patients.

AIM: To make an initial assessment of the periodontal diagnostic potential of immunoreactive matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid (GCF) by comparison with elastase activity which has previously been associated with disease severity and progression. METHODS: GCF was collected from molar and premolar sites of 16 chronic adult periodontitis patients before treatment and 13 of this group 2 weeks after scaling and root planing. Samples were analysed for MMP-8 by immunofluorometric assay and for elastase activity with a fluorogenic substrate. RESULTS: Mean patient clinical parameters and GCF enzyme totals both decreased significantly after treatment. Total MMP-8 levels and elastase activities generally correlated significantly with gingival and bleeding indices. For GCF concentrations, only MMP-8 showed a significant fall after treatment, and some significant correlations with clinical parameters. Amounts of the 2 enzymes correlated significantly with each other. CONCLUSIONS: Similarities between MMP-8 and elastase probably reflect the fact that both enzymes are associated mainly with neutrophils: MMP-8 levels may have fallen more after treatment because the assay, unlike that for elastase, would most likely not have detected much enzyme bound to alpha-macroglobulin. The immunoassay for MMP-8 is more specific and convenient than functional collagenase assays, and might be suitable for monitoring the periodontal condition.

Adult↗
PubMed2000

Rehabilitation of a periodontal patient with rapidly progressing marginal alveolar bone loss: 1-year follow-up.

BACKGROUND: The present case report describes a 1-year follow-up of functional rehabilitation of a young periodontal patient with severely advanced, rapidly progressing marginal bone loss treated by using a new splinting material, i.e., glass fiber-reinforced composite (FRC). Apart from one single tooth, the young man had retained all his natural teeth. TREATMENT: Periodontal treatment was based on cleaning and root planing enabled by partial-thickness-flap operations. This method was selected to avoid further damage to the remaining alveolar bone. After healing for 6 months, a cavity retained internal FRC splint was constructed and 1 missing lower molar was replaced by an inlay-retained FRC resin-bonded fixed partial denture (FPD). A 12 months follow-up period revealed a healthy periodontium and good functional and esthetic results. CONCLUSIONS: The new material allows the use of periodontal treatment methods instead of prosthetic alternatives, which until now have been a more generally used approach in the treatment of severely advanced periodontal cases. Internal fiber-reinforced composite splinting being affordable for the patient, easy for the clinician to construct and giving good esthetic and functional results, suggests that the method may be a valuable aid in periodontal treatment.

Adult↗
PubMed2000

Disease progression in periodontally treated and untreated patients--a retrospective study.

BACKGROUND, AIMS: The aim of this retrospective study was to assess the effect of regular supportive periodontal treatment on disease progression in patients with moderate to advanced periodontitis. METHOD: We compared radiographic change of interdental bone level and number of teeth at 2 time points in 3 patient groups (mean age 46 years): group A, periodontally untreated patients (n= 14) who dropped out during initial therapy; group B, non-compliant patients (n=26), who discontinued supportive periodontal therapy after ca. 2 years of maintenance; group C, compliant patients (n=27), who regularly attended the maintenance program for 7 years. Periodontal treatment was performed as scaling and root planing or flap surgery in groups B and C. All 3 groups were re-examined ca. 7 years after the initial examination. RESULTS: Patients in group A lost 3.8 teeth (0.5 teeth/year), those in group B 3.2 (0.4 teeth/year), and in group C, patients lost 2.0 teeth (0.2 teeth/year). About half of the patients lost no teeth (group A 43%, B 42%, C 55%), and only 17 subjects lost more than 3. At the 2nd examination, an increase in interdental bone was found only in group C (+0.13 mm), while groups A and B lost 0.57 mm and 0.31 mm of alveolar bone level, respectively (p<0.05 group C versus A and B). CONCLUSIONS: Systematic periodontal treatment stops interdental bone loss and decreases the rate of tooth loss in most cases. Periodontal surgery without regular follow-up care cannot prevent further periodontal destruction, but it can delay it.

Alveolar Bone Loss↗
PubMed2000

Persistent bacterial colonization of Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in periodontitis and its association with alveolar bone loss after 6 months of therapy.

BACKGROUND, AIMS: The purpose of this study was to determine whether the presence of bacterial antigens for Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque of periodontitis patients after periodontal treatment was associated with progressive alveolar bone loss. METHOD: 39 (39) subjects in good general health previously diagnosed with adult periodontitis within the last 2 years, and still presenting with probing depth >5 mm in 2 to 6 teeth, were studied. All subjects were treated with scaling and root planing. Half of the subjects were randomly assigned to receive adjunctive systemic doxycycline (200 mg the 1st day, then 100 mg per day for 21 days). Subgingival plaque samples were taken at baseline, 1, 3 and 6 months after therapy. A modified ELISA test (Evalusite, Periodontal Test Kit, Eastman Kodak Co., Rochester, NY) was used to test for plaque antigens associated with P. gingivalis, P. intermedia and A. actinomycetemcomitans. Progressive alveolar bone loss was determined using digital subtraction radiography with standardized radiographs taken at baseline and 6 months after treatment. RESULTS: The presence of P. gingivalis in plaque after treatment was significantly associated with progressive bone loss (positive predictive value 84%, negative predictive value 85%, odds ratio 31.9, p<0.0001). In contrast, the presence of P. intermedia in plaque after treatment was not indicative of progressive loss (positive predictive value 39%, negative predictive value 82%). Too few sites had evidence of A. actinomycetemcomitans to be amenable to statistical analysis. No significant difference in bone loss was attributable to the systemic antibiotic therapy. CONCLUSION: These data indicated that, in this population, the presence of P. gingivalis in plaque after treatment might be indicative of progressive alveolar bone loss.

Adult↗
PubMed2001

Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease.

AIM: A clinical trial was performed to determine (i) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and (ii) the incidence of recurrent disease during 12 years of maintenance following active therapy. MATERIAL AND METHODS: Each of the 64 subjects included in the trial showed signs of (i) generalized gingival inflammation, (ii) had a minimum of 12 non-molar teeth with deep pockets (> or =6 mm) and with > or =6 mm alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non-surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP non-surgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) 3-4 times per year. Sites that at a recall appointment bled on gentle probing and had a PPD value of > or =5 mm were exposed to renewed subgingival instrumentation. Comprehensive re-examinations were performed after 1, 3, 5 and 13 years of SPT. If a subject between annual examinations exhibited marked disease progression (i.e., additional PAL loss of > or =2 mm at > or =4 teeth), he/she was exited from the study and given additional treatment. RESULTS: It was observed that (i) surgical therapy (SU) was more effective than non-surgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets, (ii) more SRP-treated subjects exhibited signs of advanced disease progression in the 1-3 year period following active therapy than SU-treated subjects. CONCLUSION: In subjects with advanced periodontal disease, surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy.

Adult↗
PubMed2001

Success rates in periodontal treatment as related to choice of evaluation criteria. Presentation of an evaluation criteria staircase for cost-benefit use.

BACKGROUND, AIMS: The aim of the present investigation was to determine the success rates of treatment of 36 patients with moderate to advanced periodontal disease as related to different clinical and radiographic criteria. METHOD: The treatment comprised oral hygiene education, subgingival scaling and root planing, and when judged indicated, periodontal surgery. An "evaluation criteria staircase" comprising 5 levels was introduced to be utilized for evaluation of the treatment results in 4 proximal sites (1 in each quadrant) which were followed for 3 years. The highest level of the staircase (level 1) is the most challenging and comprises the traditonal criteria for "perfect" periodontal health, while the lower levels are gradually less demanding. RESULTS: At the follow-up examination 3 years after active treatment, 52.1% of the experimental sites fulfilled the criteria for successful treatment according to level 1. On the lowest level (level 5) which only required no further loss of alveolar bone for treatment to be considered "successful", the number of such treated sites reached 95.1%. The present data showed that even if level 5 was accepted as the evaluation criterion for "success", resulting in very few failed sites (4.9%), these sites may demand considerable extra clinical time and costs for retreatment because of their distribution among many individuals (13.2%). This clinical time increases substantially if higher levels of success are desired. From a cost-benefit point of view, it is therefore of utmost importance that not only patient compliance but also disease resistance and the value of the affected tooth for the dentition are taken into consideration when the indications for retreatment are weighed. This is especially important since many sites were found to be non-progressive for a long time, even though they did not exhibit perfect periodontal health. CONCLUSIONS: It is suggested that the "evaluation criteria staircase" presented in this paper might be a helpful clinical instrument for decision-making in individually designed and site-related retreatments of patients with periodontal disease.

Adult↗
PubMed2002

Some effects of enamel matrix proteins on wound healing in the dento-gingival region.

OBJECTIVE: The aim of the present study was to evaluate by clinical means the effect of enamel matrix proteins on the healing of a soft tissue wound produced by periodontal pocket instrumentation. MATERIAL AND METHODS: The study was performed as an intra-individual, longitudinal trial of 3 weeks duration with a double-masked, split-mouth, placebo-controlled and randomized design. The patient material was comprised of 28 subjects with moderately advanced, chronic periodontitis. Each patient presented with 3 sites in each of 2 jaw quadrants with a probing pocket depth (PPD) of >or=5 mm and bleeding following pocket probing (BoP). Baseline examination, including assessments of plaque, gingival inflammation, PPD, BoP and root dentin sensitivity, was carried out one week after oral hygiene instruction and careful self-performed plaque control. All experimental sites were scaled and root planed, and the soft tissue wall of the pocket was curetted to remove the pocket epithelium and adjacent granulation tissue. The site was carefully irrigated with saline. When the bleeding from the pocket had ceased, a 24% EDTA gel was applied in the site and retained for 2 min. This was followed by careful irrigation with saline. Left and right jaw quadrants were then randomized to subgingival application of enamel matrix derivative (Emdogain) or vehicle-control. All sites were re-examined after 1, 2 and 3 weeks. In addition, a visual analogue scale (VAS) was used to score the degree of post-treatment discomfort. The primary endpoints of treatment success were defined as (i) pocket closure (PPD <or=4 mm), (ii) no bleeding following pocket probing, (iii) no sign of gingival inflammation (GI score =0) and (iv) low degree of post-treatment discomfort (VAS <or=20). Statistical analyzes of intra-individual differences between the test and control treatments were performed by the use of Wilcoxon signed rank test. For comparison of the proportions of sites reaching the defined endpoints of treatment success, a site-based analysis was performed using 2x2 tables and the Fisher exact test. RESULTS: The endpoint "GI score =0" was reached at 16% of the sites subjected to application of Emdogain at 1 week and at 2% of the control sites (p=0.001). At 2 weeks, the corresponding figures were 25% versus 12% (p =0.028). Absence of BoP was at 1 week 57% for the Emdogain treated sites compared to 35% for the control sites (p=0.003). At 2 weeks, this endpoint was reached in 73% and 59% of the test and control sites, respectively (p=0.051). In terms of the endpoint defined for probing pocket depth, PPD <or=4 mm, no differences between test and control sites were found. At 1 week, the proportion of patients reporting a VAS score <or=20 was significantly higher for the Emdogain treated quadrants than for controls (p=0.002). CONCLUSION: The results indicated that Emdogain topically applied in instrumented pockets enhance the early healing of periodontal soft tissue wounds.

Administration, Topical↗
PubMed2002

GCF IL-1beta profiles in periodontal disease.

OBJECTIVES: Studies suggest a genetic influence on levels of interleukin-1beta (IL-1beta) in gingival crevicular fluid (GCF). Levels of IL-1beta in GCF, however, are also dependent upon the clinical parameters at the site of collection, including probing depth (PD) and level of attachment (AL). To examine this issue, IL-1beta in GCF was evaluated from patients with varying degrees of periodontal disease. The influence of both the status of the patient and the probing depth at the sampled sites were considered in the analysis. MATERIAL AND METHODS: GCF IL-1beta was determined by ELISA at 6-8 molar sites from 29 non-smoking adults with mild, moderate, or severe periodontal disease at baseline, 2 weeks, and 24 weeks following scaling and root planing. For later analysis, patients were dichotomized on the basis of disease severity (mild/moderate vs severe). Sampled sites were classified at baseline by PD as, shallow (<4 mm), intermediate (4-6 mm), or deep (>6 mm). RESULTS: PD and AL were each strongly correlated with IL-1beta levels at baseline. However, patients with severe disease had higher levels of IL-1beta in each PD category than those with mild/moderate disease. As compared to patients with mild/moderate disease, IL-1beta levels in shallow sites from patients with severe disease was elevated nearly 2 fold (p<0.001). IL-1beta levels were reduced in all groups at 2 weeks and were still significantly reduced in patients with mild/moderate disease at 24 weeks. At 24 weeks IL-1beta returned to near baseline levels in patients with severe disease. CONCLUSION: While PD and AL are each associated with increased GCF IL-1beta, patients with severe disease show higher IL-1beta GCF levels in shallow sites, suggesting that high GCF IL-1beta expression is in part a host trait, and not strictly a function of clinical parameters.

Adult↗
PubMed2002

A double-blind placebo-controlled trial of azithromycin as an adjunct to non-surgical treatment of periodontitis in adults: clinical results.

BACKGROUND/AIMS: The aim of the study was to investigate the clinical and microbiological effects of azithromycin as an adjunct to the non-surgical treatment of periodontitis in adults. Azithromycin is an antibiotic which is taken up by phagocytes and is released over long periods in inflamed tissue but requires a total of only three doses of 500 mg to produce its therapeutic effect. METHOD: 46 patients were treated in a double-blind placebo-controlled study with assessments at weeks 0, 1, 2, 3, 6, 10 and 22. Throughout the trial measurements were made of plaque, gingival bleeding, calculus, probing pocket depths and bleeding on probing. Microbiological sampling was carried out from a selected pocket >or=6 mm at each visit. The regime employed consisted of OHI, scaling and root planing at weeks 0, 1 and 2 with reinforcement of OHI and minimal scaling at weeks 6, 10 and 22. Patients were randomly assigned to receive either azithromycin, (A), or placebo capsules, (C), 500 mg, 1x daily for 3 days at week 2. 44 patients completed the study. Mean pocket depths were analysed using analysis of covariance in 3 groups with initial pocket depth values of 1-3 mm, 4-5 mm and >or=6 mm. RESULTS: The results of the microbiology have been reported in a separate paper. The clinical data showed that by week 22 a lower % of pockets initially >5 mm deep remained above that level in the 23 patients taking azithromycin (A), than the 21 taking the placebo (C), (A, 5.6%; C, 23.3%). Also at week 22, for pockets initially 4 mm or more, the test group had fewer pockets >3 mm deep (A, 26.1%; C, 44.3%), fewer failing to improve in probing depth (A, 6.6%; C, 21.6%) and fewer continuing to bleed on probing (A, 46.9%; C, 55.6%) when compared with the control group. Pocket depths initially 4-5 mm or 6-9 mm analysed by analysis of covariance showed lower mean pocket depths in the patients on azithromycin, at weeks 6, 10 and 22, (pockets initially 4-5 mm, p<0.001 on all occasions, pockets initially 6-9 mm, p<0.001, week 6; p< 0.003, week 10; p<0.001, week 22). CONCLUSIONS: Azithromycin may be a useful adjunct in the treatment of adult periodontitis, particularly where deep pockets are present.

Adult↗